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The Anti-Inflammatory Diet: Cooling the “Fires” Within

Richard E. Collins, MDTHE COOKING CARDIOLOGIST®Susan Buckley, RDN, CDE

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The Anti-Inflammatory Diet

Most people associate inflammation with conditions such as arthritis and IBS, but we are increasingly coming to understand that it is also connected to diabetes, obesity, heart disease, Alzheimer’s, cancer and even depression and mood disorders

Americans are living more and more disconnected from their natural food sources, and our diets are increasingly made up of processed foods, excess sugars and bad fats, and genetically modified foods.

The Anti-Inflammatory Diet

This is a recipe for chronic inflammation.

An anti-inflammatory diet can quiet symptoms, and turn back the tide on many health issues, with the added benefits of increased energy and, in many cases, weight loss

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What is Inflammation?

Part of a healthy immune system response

Low-level, chronic inflammation is an excessive,inappropriate inflammatory response

Can be measured with lab test: C-reactive protein

C-reactive protein (CRP) is a substance produced bythe liver in response to inflammation.

High CRP levels may put people at increased risk forcoronary artery disease, which can cause a heartattack

The Anti-Inflammatory Diet

One of the mostpowerful tools tocombat inflammationcomes not from thepharmacy, but fromthe grocery store

Many studies haveshown that componentsof foods and beveragescan have anti-inflammatory effects

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Cooking Methods/Inflammation

Also, HOW we cook our food may be asimportant as WHAT we cook as far as healthand nourishment are concerned

Food cooked at high heat in our modern,fast-paced, processed-food culture, createspotentially cancer-causing chemicals calledheterocyclic amines (HCAs) andpolycyclic aromatic hydrocarbons (PAHs)

AGEs, HCAs

Heterocyclic amines (HCAs) are created whenmeat, poultry and fish are cooked at hightemperatures –seafood has less, plant foods littleto none

Foods cooked at high temperature also containgreater levels of advanced glycation end products(AGEs) that cause more tissue damage andinflammation than foods cooked at lowertemperatures.

AGEs irritate cells in the body, damaging tissuesand increasing risk of complications from diseaseslike diabetes and heart disease.

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HCAs

Grilling, barbecuing, broiling and pan-fryingare more likely to produce HCAs than bakingor roasting – due to high temp

Propane gas grill can reach 640 degrees Fwhile a typical roasting temp is 350 degrees

Liquid cooking – boiling, steaming, poaching,stewing generates no HCAs because tempnever tops boiling point of water.

Microwave – little HCAs

PAHs

Polycyclic aromatic hydrocarbons occurwhenever fat drips on a flame, heatingelement or hot coals

PAHs waft up in the smoke and can land onfood

Can also form directly on food when it’scooked to a crisp

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PAHs

Studies have shown that exposure to HCAsand PAHs can cause cancer in animals

Many epidemiologic studies of humans havefound that high consumption of well-done,fried, or barbecued meats was associatedwith increased risks of colorectal,pancreatic, and prostate cancer.

Tips to Reduce PAHs, HCAs

Grill vegetables instead of meat! Marinate before grilling –significantly

reduces the amount of HCAs Trim the fat, remove the skin– less fat drips

into flames Partially pre-cook meats, fish, poultry in

oven or microwave before grilling Keep meat portions small – less time on

grill

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Tips to Reduce PAHs, HCAs

Cover grill with punctured aluminum foil toavoid letting meat juices drip onto flame

Keep water spray bottle on hand to tameflames

Flip frequently

Remove all charred

or burnt portions

before eating

What About Cooking Oils?

Different oils have different uses, and eachperforms best within a certain range oftemperatures.

Every oil has a smoke point, thetemperature at which it begins to smoke.

Oil should never be allowed to smoke as itcompromises nutritional value and releasescarcinogenic free radicals – promotesinflammation!

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Olive Oil

As an unrefined oil, extra virgin olive oilshould not be exposed to heat higher than325°F, its smoke point

Most of its characteristic flavor dissipatesunder sustained heat

Extra virgin olive oil is more suitable for useas a condiment than in most cookingapplications.

Smoke points of oils

Avocado 510 degrees F Almond 495 Sesame 445 Canola 425 Walnut 400 Olive 325 Flax 225 Resource: http://www.ebnaturalmedicine.com/wp-

content/uploads/2014/06/Spectrum-oil-guide.pdf

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Foods that PROMOTE inflammatory disease

Foods with high saturated fat content, suchas animal products and most full-fat dairyproducts

Foods with high omega-6 fatty acid contentand low omega-3 fatty acids such as partiallyhydrogenated oils, margarine, oils from corn,cottonseed, safflower, sesame and sunflower

Foods with high glycemic load, such asbagels, instant rice, white pasta, sugar

Foods that promote inflammatory disease

For some people - food with high allergypotential, such as dairy products, wheat andeggs

These inflammatory foods can increaseproduction of inflammatory mediators

Foods with high allergy potential may alsoincrease intestinal permeability, triggeringimmune response and potential increase ininflammatory disease

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Anti-Inflammatory Foods

Foods with high omega-3 fatty acids, such as coldwater fish: salmon, sardines, herring, tuna;flaxseeds, walnuts

Foods with high levels of antioxidants, such asvegetables, citrus fruits, cherries, garlic, onion andtea, cocoa

Spices, in particular, ginger, garlic, rosemary,turmeric, oregano, cayenne, clove and nutmeg

Low glycemic index/load foods

Mediterranean Diet – high in omega 3 fats, F/V,nuts and seeds and whole grains

Recipe: Blueberry Almond Turtles

Almonds

Blueberries

Bittersweet

Dark chocolate

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Nuts

Frequent consumption of nuts, has been shown in multiplestudies to be inversely related to inflammatory markers inthe body

A study published in The American Journal of ClinicalNutrition in 2011 found that over a 15-year period, men andwomen who consumed the most nuts had a 51% lower risk ofdying from an inflammatory disease compared with thosewho ate the fewest nuts.

Study published in the journal Circulation found that subjectswith lower levels of vitamin B6 – found in most nuts – hadhigher levels of inflammatory markers.

Blueberries

Numerous studies show that blueberries can:

Improve heart health

Reduce cancer risk

Fight UTIs

Improve brain health

Are loaded with antioxidants

Excellent anti-inflammatory food

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Cocoa

Study in the American Journal of ClinicalNutrition found that 40 g of cocoa powder(about 5 Tbsp) per day for a period of 4weeks reduced inflammatory mediatorsinvolved in development of atherosclerosis insubjects at high risk of CVD

Helps to lower HTN

Recipe: Blueberry Almond Turtles

Almonds

Blueberries

Bittersweet

Dark chocolate

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Recipe: Overnight Oatmeal

Steel cut oats

Unsweetened almond milk

Unsweetened apple juice

Apple

Brown sugar

Cinnamon

Raisins

Walnuts

Omega 3 fatty acids from Omega Swirl

Whole Grains

Every day, more and more studies show thebenefits of whole grains

SLOW carbs, not NO carbs!

Studies show that regular whole grainconsumption reduces the risk of bothcardiovascular disease and diabetes

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Whole Grains

Scientists at the National Institutes of Health,followed 259 healthy women for 2 years, to see ifwhole grain consumption lowered levels of C-reactive protein.

They found that women who ate even small amountsof whole grains – up to 1 serving a day – had, onaverage, 11.5% lower concentration of hs-CRP(measures inflammation) in their blood.

Women eating a full serving or more of whole grainhad, on average, 12.3% lower CRP levels.

Omega 3s Fatty Acids

Omega Swirl

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Omega 3 Fatty Acids

Omega-3 fatty acids are found in fish, such as salmon,tuna, and halibut, other seafoods including algae andkrill, flaxseeds and nut oils.

Also known as polyunsaturated fatty acids (PUFAs),omega-3 fatty acids play a crucial role in brain function

May reduce the risk of heart disease

Helps lower high blood pressure

The American Heart Association (AHA) recommendseating fish (particularly fatty fish such as mackerel, laketrout, herring, sardines, albacore tuna, and salmon) atleast 2-3 times a week.

Omega 3 Fatty Acids

Hundreds of studies suggest that omega-3s mayprovide benefits to a wide range ofdiseases: cancer, asthma,depression, cardiovasculardisease, ADHD, and autoimmune diseases, such asrheumatoid arthritis.

All these diseases have a common genesis ininflammation

Typical dosage is 1,000 – 4,000 mg/day dependingon health status and medications

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Balanced Omega 6/Omega 3

EPA and DHA from fish oils are more biologicallypotent than alpha-linolenic acid (ALA) fromflaxseeds and walnuts

A balanced intake of omega-6 and omega-3 fattyacids is anti-inflammatory

Overconsumption of omega-6 fats in relation toomega-3 fats leads to inflammation (common)

Most appropriate ratio of omega-6 to omega-3 fattyacids is approximately 2:1.

Polyunsaturated Fat

Omega 6 to Omega 3 should be in a 2:1 ratio

Typical American diet: more like 20:1 ratio

We overeat Omega 6 fats and don’t getenough Omega 3 fats

Opposing but complimentary functions in thebody

Omega 6 – pro-inflammatory

Omega 3 – anti-inflammatory

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Omega 6

Widespread in foods

Vegetable oils (safflower, sunflower, sesame, corn)

Salad dressings made with above oils

Margarines

Crackers, bread, chips, popcorn, etc

Increase inflammation in the body

Reduce intake of Omega 6 fats

Omega 3 Fats

Increase HDL “good”cholesterol Reduce blood clot formation Suppresses inflammation in the body Decreases triglyceride levels in blood Decreases risk/incidence of sudden death and

MI Inhibits growth of plaque Promote arterial relaxation, lowers BP Reduce susceptibility to arrhythmias

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Sources of Omega 3 fats

Increase intake of Omega 3 fats

Choose fatty fish (salmon, sardines, herring,trout)

Flaxseed and flaxseed oil

Edamame

Omega-3 eggs

Dark leafy greens, wheat germ

Walnuts and walnut oil, pumpkin seeds

Fish Oil Supplements

Two omega-3 fatty acids – eicosapentaenoic acid(EPA) and docosahexaenoic acid (DHA) found tohelp lower triglycerides, reduce blood clotting anddecrease inflammation

AHA: healthy people should get about 1,000 mg perday of EPA and DHA

High Blood pressure: 2,000 mg per day High triglycerides: 2-4 grams per day (under care of

health care provider) Fish oil supplements – quality matters Omacor/Lovaza/Vascepa – prescription fish oils

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Fish Oil Supplements

Over the counter brands:

Nordic Naturals

Carlson

Cinnamon

Cinnamon has a long history both as a spice and asa medicine.

Seasoning a high carb food with cinnamon can helplessen its impact on your blood sugar levels.

Cinnamon slows the rate at which the stomachempties after meals, reducing the rise in blood sugarafter eating (Ceylon cinnamon is best)

Adding cinnamon to the rice pudding lowered thegastric emptying rate from 37% to 34.5% andsignificantly lessened the rise in blood sugar levelsafter eating. Am J Clin Nutr. 2 007 Jun;85(6):1552-6.

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Recipe: Overnight Oatmeal

Steel cut oats

Unsweetened almond milk

Unsweetened apple juice

Apple

Brown sugar

Cinnamon

Raisins

Walnuts

Omega 3 fatty acids from Omega Swirl

Recipe: Pumpkin Black Bean Soup

Black beans

Tomatoes

Chicken broth

Onion and garlic

Pumpkin

Black bean burgers

Tea seed oil

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Black beans

The "protein-plus-fiber" combination inblack beans and other legumes is key to theiroutstanding support for blood sugar balanceand blood sugar regulation

Numerous studies show decreased risk oftype 2 diabetes following increased intake offiber from plant foods (and especiallylegumes)

Black beans

Much of the research on bean intake and decreasedrisk of cardiovascular disease focus on theoutstanding soluble fiber content of beans.

One cup of black beans provides over 4 grams ofsoluble fiber, and this is precisely the type of fiberthat researchers have found especially helpful inlower blood cholesterol levels.

Decreased risk of coronary heart disease (CHD)and myocardial infarct (MI, or heart attack) haveboth been associated with increased intake ofsoluble fiber from food, especially beans

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Anti-Inflammatory Fruit/Vegetables

A high fruit and vegetable intake has been shown tobe associated with a low level of inflammation

Fruit and vegetable intake has been shown to beinversely related to oxidative stress andinflammation in type 2 diabetics

Consuming a diet high in fruits and vegetables isassociated with lower risks for numerous chronicdiseases, including cancer and cardiovasculardisease.

Tomatoes, onions, garlic, pumpkin

Pumpkin

A 2010 article published in "Nutrition ResearchReviews" notes that pumpkin reduces inflammation

Alpha- and beta-carotene antioxidants are a class ofcarotenoids that convert into usable vitamin A withinthe body.

Beta-carotene is anti-inflammatory

Alpha-carotene hinders tumor growth, slows agingand protects against cataracts.

Additionally, carotenoids reduce the risk ofcardiovascular disease and boost immunity.

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Recipe: Pumpkin Black Bean Soup

Black beans

Tomatoes

Chicken broth

Onion and garlic

Pumpkin

Black bean burgers

Tea seed oil

Recipe: Spicy Cherry Salsa

Cherries and cherry juice

Cider vinegar

Garlic

Agave

Ginger, allspice,

cayenne, cardamom,

cinnamon

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Cherries

Scientific studies show that cherries are packed withunique anthocyanins and other compounds thatnaturally mediate the inflammatory process

These compounds deliver comparable anti-inflammatoryactivity to ibuprofen (Advil®) and naproxen (Aleve®)7—but without the significant side effects!

The compounds found in cherries modulate numerouspathways to protect against other conditions associatedwith inflammation—including cancer, cardiovasculardisease, metabolic syndrome, and Alzheimer’s disease.

Cherries

Tart cherry constituents can switch critical genes offand on

Tart cherries were ranked 14th among the top 50foods for highest antioxidant content per serving—surpassing such well-known antioxidant sources asred wine and dark chocolate, according to theAmerican Journal of Clinical Nutrition

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Guard Against Degenerative Disease and Inflammation with Tart Cherries

Physical exercise can induce muscle damage thatgenerates inflammation and with it, burning,stiffness, and pain. The effect worsens with age.

Standard treatment with nonsteroidal anti-inflammatory drugs such as Ibuprofen (Advil®)involves potentially deadly adverse effects, suchas stroke.

Evidence shows that the complex anthocyanins andphenols in tart cherries provides superior protectionagainst muscle injury—by safely inhibiting the painand inflammatory effects.

Tart Cherries

The potent components in tartcherries have been demonstratedto deliver high-level protectionagainst inflammatory anddegenerative diseases, includingcardiovascular disease,metabolic syndrome, andneurodegenerative diseasessuch as Alzheimer’s.

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Tart Cherries

A study conducted by scientists at Boston University foundthat intake of cherry extract reduced the risk of gout attacksin those who suffered recurrent gout attacks by 45%

Additionally, the researchers discovered that when cherryintake was combined with allopurinol use, the risk for goutattacks was reduced by 75%versus no intervention.

What’s more, these results persisted even acrosssubgroups stratified for sex, obesity status, purine intake,and alcohol use

Tart cherries appear to be a natural—and safe—way toinhibit the key gout pathway.

Sweet Cherries

An impressive study released in 2013 reported thatafter 28 days of consumption, sweet cherries werefound to selectively and significantly reduce anumber of biomarkers associated with inflammatorydiseases.

Among other decreased inflammation indicators,blood levels of C-reactive protein were reduced byover 20%

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Garlic

Garlic has been used as a medicinal plantsince ancient times

Researchers have shown that garlic maypromote an anti-inflammatory environmentby cytokine modulation that leads to overallinhibition of NF-(kappa)B activity

NF-(kappa)B is a central transcription factorin adaptive immunity and a central regulatorof pro-inflammatory gene expression

Ginger

Ginger contains very potent anti-inflammatorycompounds called gingerols.

These substances are believed to explain why so manypeople with osteoarthritis or rheumatoid arthritis experiencereductions in their pain levels and improvements in theirmobility when they consume ginger regularly.

In two clinical studies involving patients who responded toconventional drugs and those who didn't, physicians foundthat 75% of arthritis patients and 100% of patients withmuscular discomfort experienced relief of pain and/orswelling.

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Spices: Ginger

Ginger belongs to the same botanical familyas turmeric and cardamon

Has been used as an anti-inflammatoryagent for centuries

Researchers have found that ginger inhibitsprostaglandin biosynthesis – similar toNSAIDs

Spices: Ginger

Ginger extract also inhibits the induction of severalgenes involved in the inflammatory response

In a study of 261 people with osteoarthritis (OA) ofthe knee, those who received a ginger extract twicedaily experienced less pain and required fewer pain-killing medications compared to those who receivedplacebo.

For analgesic purposes, 2 to 4 grams fresh gingerjuice or extract taken daily is recommended

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Zyflamend

Food- and herb-based supplement thatcombines ten of the very top anti-inflammatory concentrates

One of the top herbal supplements sold inthe world

Rosemary, Turmeric, Ginger, Holy Basil,Green Tea, Hu Zhang, ChineseGoldthread, Barberry, Oregano, BaikalSkullcap

Cayenne

Arthritis is generally thought to be an inflammatorydisorder resulting in destruction of the tissues lining thejoints.

Cayenne pepper has been used topically to increaseblood supply and provide a warming sensation to affectedjoints.

Taken internally as a supplement, cayenne may also helpto reduce joint inflammation through its antioxidantactivity.

Applied as a topical cream, gel or patch, capsaicin worksby depleting the amount of a neurotransmitter calledsubstance P that sends pain messages to the brain.

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Capsaicin

Many studies have shown that capsaicineffectively reduces pain fromosteoarthritis, rheumatoid arthritis andfibromyalgia.

In a 2010 German study, joint paindecreased nearly 50% after three weeks' useof 0.05 percent capsaicin cream.

Recipe: Spicy Cherry Salsa

Cherries and cherry juice

Cider vinegar

Garlic

Agave

Ginger, allspice,

cayenne, cardamom,

cinnamon

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Recipe: Apricot Chicken Tagine

Canola oil

Chicken

Onion, garlic, ginger

Turmeric

Nutmeg

Cinnamon

Saffron

Vegetable broth

Apricots

Garbanzo beans

Tomatoes

Cashews

Cilantro

Spices: Turmeric

Curcumin is a naturally occurring chemicalcompound that is found in the spice turmeric

Turmeric is a mustard-yellow spice from Asia.

Main ingredient in curry

Laboratory and animal research hasdemonstrated anti-inflammatory,antioxidant, and anti-cancer properties ofturmeric and its constituent curcumin.

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Spices: Turmeric

Researchers tested turmeric extracts inanimal models and found evidence of anti-arthritic and anti-Alzheimer’s disease efficacy

They found that curcuminoid extract inhibitsa transcription factor, NF-KB, from beingactivated in the joint

Typical dose used therapeutically 400 mgtwice a day

Turmeric

One of the most comprehensive summaries ofturmeric benefits studies to date was published by therespected ethnobotanist James A. Duke, Phd., in theOctober, 2007 issue of Alternative & ComplementaryTherapies, and summarized in the July, 2008, issue ofthe American Botanical Council publication HerbClip.

Reviewing some 700 studies, Duke concluded thatturmeric appears to outperform many pharmaceuticalsin its effects against several chronic, debilitatingdiseases, and does so with virtually no adverse sideeffects.

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Turmeric

Alzheimer's disease: Duke found more than 50studies on turmeric's effects inaddressing Alzheimer's disease.

The reports indicate that extracts of turmeric containa number of natural agents that block the formationof beta-amyloid, the substance responsible forthe plaques that slowly obstruct cerebral functionin Alzheimer's disease.

Dosages of 400 to 600 mg, taken three times dailyhave been used in studies

Turmeric

Arthritis: Turmeric contains more than two dozenanti-inflammatory compounds, including sixdifferent COX-2-inhibitors (the COX-2 enzymepromotes pain, swelling and inflammation; inhibitorsselectively block that enzyme).

By itself, writes Duke, curcumin - the component inturmeric most often cited for its healthful effects - is amultifaceted anti-inflammatory agent, and studies ofthe efficacy of curcumin have demonstrated positivechanges in arthritic symptoms.

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Salicylic Acid

Salicylic acid is the active component ofwillow-bark, long used as a folk remedy forpain

Aspirin is a synthetic derivative of willowbark

Foods high in salicylic acid: berries, grapes,broccoli, spinach, chili peppers,cinnamon, ginger, rosemary, nutmeg,sage, basil, strawberries

Mediterranean Diet

Studies have found that the Mediterraneandiet can produce beneficial changes onmarkers of inflammation, including reductionin C-reactive protein and pro-inflammatory cytokines, as well as reducedplatelet aggregation and improvedendothelial function

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Mediterranean Diet

High cardiovascular risk participants from thePREDIMED trial eating a Mediterranean diet,rich in olive oil and nuts, showed improvedlipid profiles, decreased insulin resistanceand reduced concentrations ofinflammatory molecules compared withthose allocated to a low-fat diet

Tagine

Definition: A tagine is like a casserole dishused in north African cooking, mostcommonly in Morocco.

It consists of two pieces - a plate like bottomand a conical shaped lid. The bottom doublesas a serving dish.

Can purchase in cooking stores or online.

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Recipe: Apricot Chicken Tagine

Canola oil

Chicken

Onion, garlic, ginger

Turmeric

Nutmeg

Cinnamon

Saffron

Vegetable broth

Apricots

Garbanzo beans

Tomatoes

Cashews

Cilantro

Anti-Inflammatory Diet

• 90% plant-based foods (or more)• Fresh produce at every meal – Fruits and veggies• No processed foods (made in a factory)• No fried foods, no cheap oils• Good fats: extra virgin olive, walnuts, and omega 3fats in fatty fish like salmon, sardines, herring and tuna• Lots of avocados, fresh tomatoes, cucumbers,herbs and spices, etc.• Low glycemic foods like berries, and legumes• Green tea and water as your beverages

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Cook well, live long . . .

Richard Collins, MD and

Susan Buckley, RDN, CDE